First-episode Psychosis In Adolescents Research Articles

4.69 Neurocognitive Functioning and Tobacco Use as Predictors for the Onset of First-Episode Psychosis in Adolescents

4.69 Neurocognitive Functioning and Tobacco Use as Predictors for the Onset of First-Episode Psychosis in Adolescents

Lived experiences of adolescents admitted for first-episode psychosis in South Africa.

First-episode psychosis is common in adolescents and can be distressful to the person experiencing it for the first time. However, there is limited research globally and specifically in Africa about the lived experiences of adolescents admitted into a psychiatric facility for first-episode psychosis. To understand the adolescents' experiences of psychosis and receiving treatment in a psychiatric facility. Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital, Cape Town, South Africa. This was a qualitative study that used purposive sampling to recruit 15 adolescents with first-episode psychosis and admitted to the Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital in Cape Town, South Africa. Individual interviews were audio recorded, transcribed and analysed using thematic analysis consisting of both inductive and deductive coding. The participants described negative experiences of their first episode psychosis, provided varying explanations for their first episode psychosis and had the insight that cannabis precipitated their episodes. They described both positive and negative interactions with both the other patients and staff. They did not wish to return to the hospital again following their discharge. Participants stated that they wanted to change their lives, return to school and try to prevent a second episode of psychosis. This study provides insights into the lived experiences of adolescents presenting with first-episode psychosis and calls for future research to delve deeper into factors that support or enable recovery among adolescents with psychosis. The findings of this study call for improving the quality of care in the management of first-episode psychosis in adolescents.

First episode-psychosis: Short- and long-term outcomes and related features predicting the transition to schizophrenia

IntroductionThe occurrence of a first episode-psychosis in adolescents or young adults represents a difficult struggle with an uncertain and divergent outcome, since the clinician does not have at his disposal the clinical elements sufficient to predict these different disease trajectories.ObjectivesOur aims are to describe the socio-demographic, clinical characteristics and the short and long-term outcomes of a first episode-psychosis and to identify the predictive factors of the transition to schizophrenia.MethodsWe conducted a retrospective study about 117 patients hospitalized for a first episode-psychosis in the Psychiatric Department of Monastir (Tunisia). Sociodemographic and clinical features were collected using a pre-established form.ResultsFirst-episode psychosis affected young male subjects with low educational level. Stressors were present in 54.7%. An 8-week prodromal phase preceded the onset of the disorder in 59%. The disorder course included diagnosis of: Brief psychotic disorder (32.5%), schizophrenia (31.6%) and bipolar disorder (18.8%). The short-term outcome was characterized by a complete remission rate of 58.1% at 3 months and 37.6% at 6 months. The long-term outcome was marked by a high rate of lost to follow-up: 70.8% after 5 years. The transition to schizophrenia was linked to the presence of delirium of influence and the absence of favorable course at 3 months.ConclusionsOur results led to the identification of the profile of patients with a first episode-psychosis and the factors correlated with a diagnosis of schizophrenia. Indeed, the determination of risk factors would make it possible to adapt earlier the care.DisclosureNo significant relationships.

Adapting cognitive behavioural therapy for adolescents with psychosis: insights from the Managing Adolescent first episode in psychosis study (MAPS)

ABSTRACT Background Onset of psychosis commonly occurs in adolescence, and long-term prognosis can be poor. There is growing evidence, largely from adult cohorts, that Cognitive Behavioural Therapy for Psychosis (CBTp) and Family Interventions (FI) can play a role in managing symptoms and difficulties associated with psychosis. However, adolescents have distinct developmental needs that likely impact their engagement and response to talking therapy. There is limited guidance on adapting CBTp to meet the clinical needs of under-eighteens experiencing psychosis. Method This educational clinical practice article details learnings from therapists and supervisors working with young people (aged 14–18 years) with psychosis during the Managing Adolescent first-episode Psychosis: a feasibility Study (MAPS) randomised clinical treatment trial, supplemented by findings from nested qualitative interviews with young people receiving CBTp. Results Suggested are given for tailoring CBTp assessment, formulation and interventions to meet the developmental and clinical needs of adolescents with psychosis. Developmentally appropriate techniques and resources described. Conclusions Early indications from MAPS study indicate this developmentally tailored approach is an acceptable, safe and helpful treatment for young people with psychosis. Further research is needed to develop empirically grounded and evaluated CBTp for adolescents.

Psychological intervention, antipsychotic medication or a combined treatment for adolescents with a first episode of psychosis: the MAPS feasibility three-arm RCT.

When psychosis emerges in young people there is a risk of poorer outcomes, and access to evidence-based treatments is paramount. The current evidence base is limited. Antipsychotic medications show only a small benefit over placebo, but young people experience more side effects than adults. There is sparse evidence for psychological intervention. Research is needed to determine the clinical effectiveness and cost-effectiveness of psychological intervention versus antipsychotic medication versus a combined treatment for adolescents with psychosis. The objective of Managing Adolescent first-episode Psychosis: a feasibility Study (MAPS) was to determine the feasibility of conducting a definitive trial to answer the question of clinical effectiveness and cost-effectiveness of these three treatment options. This was a prospective, randomised, open-blinded, evaluation feasibility trial with a single blind. Participants were allocated 1 : 1 : 1 to receive antipsychotic medication, psychological intervention or a combination of both. A thematic qualitative study explored the acceptability and feasibility of the trial. Early intervention in psychosis services and child and adolescent mental health services in Manchester, Oxford, Lancashire, Sussex, Birmingham, Norfolk and Suffolk, and Northumberland, Tyne and Wear. People aged 14-18 years experiencing a first episode of psychosis either with an International Classification of Diseases, Tenth Revision, schizophrenia spectrum diagnosis or meeting the entry criteria for early intervention in psychosis who had not received antipsychotic medication or psychological intervention within the last 3 months. Psychological intervention involved up to 26 hours of cognitive-behavioural therapy and six family intervention sessions over 6 months, with up to four booster sessions. Antipsychotic medication was prescribed by the participant's psychiatrist in line with usual practice. Combined treatment was a combination of psychological intervention and antipsychotic medication. The primary outcome was feasibility (recruitment, treatment adherence and retention). We used a three-stage progression criterion to determine feasibility. Secondary outcomes were psychosis symptoms, recovery, anxiety and depression, social and educational/occupational functioning, drug and alcohol use, health economics, adverse/metabolic side effects and adverse/serious adverse events. We recruited 61 out of 90 (67.8%; amber zone) potential participants (psychological intervention, n = 18; antipsychotic medication, n = 22; combined treatment, n = 21). Retention to follow-up was 51 out of 61 participants (83.6%; green zone). In the psychological intervention arm and the combined treatment arm, 32 out of 39 (82.1%) participants received six or more sessions of cognitive-behavioural therapy (green zone). In the combined treatment arm and the antipsychotic medication arm, 28 out of 43 (65.1%) participants received antipsychotic medication for 6 consecutive weeks (amber zone). There were no serious adverse events related to the trial and one related adverse event. Overall, the number of completed secondary outcome measures, including health economics, was small. Medication adherence was determined by clinician report, which can be biased. The response to secondary outcomes was low, including health economics. The small sample size obtained means that the study lacked statistical power and there will be considerable uncertainty regarding estimates of treatment effects. It is feasible to conduct a trial comparing psychological intervention with antipsychotic medication and a combination treatment in young people with psychosis with some adaptations to the design, including adaptations to collection of health economic data to determine cost-effectiveness. An adequately powered definitive trial is required to provide robust evidence. Current Controlled Trials ISRCTN80567433. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 4. See the NIHR Journals Library website for further project information.

Discontinuing Cannabis Improves the Long-Term Course of Psychosis

Cannabis contributes to the risk for first-episode psychosis in adolescents and young adults. These investigators used data from an interventional

Clinical high risk for psychosis in childhood and adolescence: findings from the 2-year follow-up of the ReARMS project.

The clinical significance and the prognostic value of clinical high risk (CHR) for psychosis, while substantially corroborated in adults, remains less firmly established in children and early adolescents. This follow-up study, developed within the Reggio Emilia At Risk Mental States project, is meant to contribute to the reduction of such lacuna, and has two main aims: (1) to characterize the clinical profile of help seekers [stratified in non-CHR, CHR and first episode psychosis (FEP)] referred to child-adolescent mental health services; and (2) to monitor the cumulative transition rate from CHR to FEP in adolescents at the follow-up of 12 and 24months. 112 adolescents (aged 13-18years) were assessed with the Comprehensive Assessment of At-Risk Mental States and the Schizophrenia Proneness Instrument, Child and Youth version. 51 subjects met CHR criteria (45.5% of the sample) and 33 subjects met FEP criteria (29.5%) at baseline. The criterial transition rate from CHR to FEP was 7% over 12months and 13% over 24months; higher rates of cumulative transition were detected when also functional transition (indexed by the consensual introduction of antipsychotic medication by the treating clinical staff) was considered. The identification of CHR for psychosis in help-seeking adolescents is feasible and clinically relevant. Studies conducted in real world, publicly funded components of the national health system, should take into consideration not only criterial, psychometric transition, but also functional equivalents of transition.

Oxidative Stress and DNA Damage in Untreated First-Episode Psychosis in Adolescents

Objective: Oxidative stress has been reported to play a role in the psychopathology of schizophrenia, though only a few studies have investigated the relationship between early-onset schizophrenia and oxidative stress. The aim of the present study is to evaluate the level of oxidative stress and the presence of DNA damage in first-episode psychosis (FEP) in adolescents. Methods: This study was conducted in the Department of Child Psychiatry of the Dicle University Hospital. It included 20 adolescent patients (age 11-17 years) with psychosis (acute psychosis, schizophreniform disorder, or schizophrenia) according to DSM-IV criteria who had received no previous psychiatric therapy (patient group) and 20 age/gender-matched healthy adolescents (control group). Structured psychiatric interviews [Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version (K-SADS-PL) and Positive and Negative Symptom Scale (PANSS)] were conducted on the patients, and the Clinical Global Impressions (CGI) scale was used to evaluate the severity of disease. Glutathione peroxidase (GPx), superoxide dismutase (SOD), coenzyme Q (CoQ), and 8-hydroxy-2-deoxyguanosine (8-OHdG) levels were determined using the ELISA method and commercial ELISA kits. Results: The mean age was 14.5 ± 1.6 years in the FEP group (male-to-female ratio: 8/12) and 14.4 ± 1.5 years in the control group (male-to-female ratio: 8/12). There were no differences between the patient and control groups in terms of SOD, GPx, or 8-OHdG values (p > 0.05). Conclusions: This study on DNA damage and oxidative stress in FEP in adolescents had a small sample size, and our data suggest that oxidative stress is associated with a chronic disease course rather than being an early sign of early-onset schizophrenia.

Neuropsychological assessment of memory in child and adolescent first episode psychosis: Cannabis and the «paradox effect»

IntroductionThe importance of neuropsychological functioning in First-Episode Psychosis (FEP) has led to the publication of a growing number of studies in this area of research. The present study pursued three goals: first, to examine verbal and visual memory in a sample of Child and Adolescent FEP, second, to evaluate the effect of other cognitive domains on verbal and visual memory, and finally, to examine the relationship between performance in this cognitive dimension and the use of cannabis at this age. MethodA sample of 41 FEPs and 39 healthy subjects were evaluated. The variables assessed were verbal and visual memory, attention, working memory, processing speed, mental flexibility, verbal fluency, motor coordination, planning ability and intelligence. ResultsOur results found impairment of short and long-term recall of verbal memory, and short-term visual memory in early psychosis. They also found relationships between cognitive dimensions, such as visual memory and intelligence and motor coordination. Finally, a «paradoxical» effect was found in patients who used cannabis, as the FEP consumers performed the visual memory test better than those who had not used it. ConclusionsPatients showed impairment of short and long-term recall of verbal information and short-term visual reproduction. In the second place, motor coordination and intelligence influenced short-term visual memory in patients in the early stages of the illness. Third, use of cannabis in patients with FEP was associated with better performance in the test that evaluated the short-term visual memory, as measured by task completion time, that is, efficiency in performing the test. However, when measured by task execution accuracy, their visual memory was no better than the controls.

History of depression and previous suicide attempt predict increased risk of suicide attempt following diagnosis of first-episode psychosis

Question: What is the prevalence of suicide attempts, and what are the predictors of suicide attempts, in children and adolescents with first-episode psychosis? Population: A total of 110 children and...

Twenty-Four Months of Antipsychotic Treatment in Children and Adolescents With First Psychotic Episode

The Child and Adolescent First-Episode Psychosis Study is a longitudinal study of early-onset first psychotic episodes. This report describes the naturalistic psychopharmacological treatment administered during a 24-month follow-up period, as well as discontinuation rates, reasons for discontinuation, and adverse effects. The sample comprised 110 patients, aged 9 to 17 years, with a first psychotic episode. Pharmacological treatment, changes, reasons for discontinuation, and the UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale were registered at 6, 12, and 24 months of follow-up. Second-generation antipsychotics, especially risperidone, quetiapine, and olanzapine, were the most commonly used. The discontinuation rate was 44.5% at 6 months, 59.1% at 12 months, and 70.9% at 24 months. Discontinuation rates or reasons for discontinuation (adverse reaction, insufficient response, and other) did not differ significantly between antipsychotics. At 6 months, significant differences were found in body mass index increase and body mass index z score increase, which were higher with olanzapine, and in neurological effects, which were higher with risperidone; at 12 and 24 months, these differences were no longer significant. High maintenance rates were found in the clozapine group, although they had higher scores on the autonomic subscale of the UKU. A long follow-up period reveals high discontinuation rates similar to those observed in adults, particularly during the first year. No differences were found between antipsychotics. Differences in adverse effects were found at 6 months but not subsequently after changes in treatment. Clozapine had a high maintenance rate, and its tolerability was comparable to that of other antipsychotics.

Assessing adolescent preference in the treatment of first‐episode psychosis and psychosis risk

The objective of this study was to investigate the treatment preferences of adolescents with a first-episode psychosis (FEP) or at-risk mental state (ARMS) for psychosis. A questionnaire was distributed to all adolescents (12-18 years) within an early intervention in psychosis service based in North-East England, during a 3-month period. Forty eligible young people responded (53% response rate). The majority of FEP and ARMS participants endorsed psychoeducational material as the most popular treatment choice (36/40; 90%) from the interventions described. Participants with FEP indicated a significant preference for using antipsychotic medications over their ARMS counterparts (75% vs. 25%). These findings support the use of psychoeducational interventions (both groups) and antipsychotic medication in adolescent FEP (as opposed to ARMS) patient groups, albeit in a small sample requiring replication. This study indicates that the generation of future treatment guidelines and the allocation of clinical resources should be informed by patient preference where possible.

Evaluación neuropsicológica de la memoria en un grupo de niños y adolescentes con un primer episodio de psicosis: consumo de Cannabis y «efecto paradójico»

The importance of neuropsychological functioning in First-Episode Psychosis (FEP) has led to the publication of a growing number of studies in this area of research. The present study pursued three goals: First, to examine verbal and visual memory in a sample of Child and Adolescent FEP, second, to evaluate the effect of other cognitive domains on verbal and visual memory, and finally, to examine the relationship between performance in this cognitive dimension and the use of cannabis at this age.A sample of 41 FEPs and 39 healthy subjects were evaluated. The variables assessed were verbal and visual memory, attention, working memory, processing speed, mental flexibility, verbal fluency, motor coordination, planning ability and intelligence.Our results found impairment of short and long-term recall of verbal memory, and short-term visual memory in early psychosis. They also found relationships between cognitive dimensions, such as visual memory and intelligence and motor coordination. Finally, a «paradoxical» effect was found in patients who used cannabis, as the FEP consumers performed the visual memory test better than those who had not used it.Patients showed impairment of short and long-term recall of verbal information and short-term visual reproduction. In the second place, motor coordination and intelligence influenced short-term visual memory in patients in the early stages of the illness. Third, use of cannabis in patients with FEP was associated with better performance in the test that evaluated the short-term visual memory, as measured by task completion time, that is, efficiency in performing the test. However, when measured by task execution accuracy, their visual memory was no better than the controls.

123. Impacts of Gene-Environment Interactions and Cannabis Use on First Episode Psychosis in Adolescents and Young Adults

123. Impacts of Gene-Environment Interactions and Cannabis Use on First Episode Psychosis in Adolescents and Young Adults

2745 – Socio-demographic characteristics of adolescents with a first psychotic episode

Introduction Time of profound change, adolescence is a critical period of development and transition between childhood and adulthood. Age life source of conflict, opposition and misunderstanding highlights some psychological fragility of life and the subject is likely to develop psychiatric disorders including psychosis. Objectives Meeting the demographic characteristics of a population of adolescents who had been hospitalized for a first episode of psychosis. Materials and methods Retrospective and descriptive performed on patient records adolescents whose ages are between 16 and 19 years hospitalized for a first episode of psychosis in psychiatric wards of Hospital Razi between January 2004 and June 2008. The socio-demographic data were collected using a pre-established form and analyzed using SPSS software version 11. Results Our series consisted of 27 boys and 13 girls with a sex ratio was 2.07. The average age of our sample was 17.9 years. About 65% of their patients were students, 20% held irregular work and 15% were unemployed. For socio-economic conditions, they were poor in 60% of cases, moderate in 35% of cases and good in only 5%. Conclusions Despite the study of socio-demographic characteristics of this population, the onset of first episode psychosis in adolescents has still practical difficulties in preventing the occurrence of this disorder remains uncertain outcome which the clinician cannot predict how scalable.

Two-year diagnostic stability in early-onset first-episode psychosis

Only one study has used a prospective method to analyze the diagnostic stability of first psychotic episodes in children and adolescents. The Child and Adolescent First-Episode Psychosis Study (CAFEPS) is a 2-year, prospective longitudinal study of early-onset first episodes of psychosis (EO-FEP). To describe diagnostic stability and the variables related to diagnostic changes. Participants were 83 patients (aged 9-17 years) with an EO-FEP consecutively attended. They were assessed with a structured interview (Kiddie-Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version) and clinical scales at baseline and after 2 years. The global consistency for all diagnoses was 63.9%. The small group of bipolar disorder had high stability (92.31%) as did the group with schizophrenia spectrum disorders (90.00%). Depressive disorder had lower stability (37.50%) and the lowest values were for psychotic disorder not otherwise specified (11.76%) and brief psychotic disorder (0%).The most frequent diagnostic shift was to schizophrenia spectrum and bipolar disorders. One group of patients did not meet the criteria for any diagnosis at follow-up. Independent predictors of change to schizophrenia spectrum disorders were lower scores on the Children's Global Assessment Scale (CGAS) and the Hamilton Depression Rating Scale. Predictors of not having a diagnosis at follow-up were the CGAS and the Strauss-Carpenter Outcome Scale. Global diagnostic stability was 63.9%. Bipolar and schizophrenia spectrum disorders were the most stable diagnoses, while depressive disorder and other psychosis the least stable. Psychosocial functioning at baseline was a good predictor of diagnosis at follow-up. These data show the need for longitudinal follow-up in EO-FEP before a stable diagnosis is reached.

A qualitative investigation of first-episode psychosis in adolescents

Although a number of researchers have explored the help-seeking pathways of individuals with psychosis, there has been little focus on the experience of illness and services in the under-18 age group. It was our aim to examine by qualitative means the experience of first-episode psychosis and the experience of accessing effective treatment, from two perspectives - that of the adolescents and that of their primary caregivers. A general inductive approach was used to analyse interviews with 12 young people receiving treatment for psychosis, and 12 carers. We found that lack of awareness of mental illness prevented access to early effective treatment. Young people relied on others to access help, and the emotional impact on caregivers was great. Experience of services was mixed, and recommendations were made for both service providers and service users. We discuss the results particularly in relation to developmental and cultural considerations and conclude that there is a need for education about mental illness and normal adolescent development on an individual and societal level.

Antipsychotic Treatment in Child and Adolescent First-Episode Psychosis: A Longitudinal Naturalistic Approach

The Child and Adolescent First-Episode Psychosis Study (CAFEPS) is a naturalistic longitudinal study of early-onset first psychotic episodes. This report describes the antipsychotic treatment during the first year and compares the most frequently used agents after 6 months. Participants were 110 patients, aged 9-17 years, with a first psychotic episode attended consecutively at six different centers. The Positive and Negative Symptom Scale (PANSS), Clinical Global Impressions (CGI), Disability Assessment Schedule (DAS), and Global Assessment of Function (GAF) scales were administered at baseline and at 6 months and the Udvalg for Kliniske Undersøgelser (UKU) Side Effects Rating Scale only at 6 months. Diagnoses at baseline were 38.2% psychotic disorder not otherwise specified, 39.1% schizophrenia-type disorder, 11.8% depressive disorder with psychotic symptoms, and 10.9% bipolar disorder, manic episode with psychotic symptoms. The most frequently used antipsychotic agents were risperidone (n = 50), quetiapine (n = 18), and olanzapine (n = 16). Patients who were prescribed olanzapine or quetiapine had more negative and general symptoms. Using the baseline score as covariate, no significant differences were found in the reductions on any scale in patients treated with risperidone, quetiapine, or olanzapine for 6 months. Weight increase was greater with olanzapine than with risperidone (p = 0.020) or quetiapine (p = 0.040). More neurological side effects appeared with risperidone than with olanzapine (p = 0.022). All side effects were mild or moderate. Second-generation antipsychotics, especially risperidone, quetiapine, and olanzapine, are the most used in our context in first psychotic episodes in children and adolescents. These three obtain similar clinical improvement, but differ in their side effects.

The genetic contribution to first psychotic episodes in children and adolescents of the child and adolescent first-episode psychosis study

Patiño-Garcia, Anaa; Santos, José Luisa; Paya, Beatrízb; Parellada, Marac; Bombin, Igorc; Sierrasesúmaga, Luisa; Castro-Fornieles, Josefinad; Baeza, Immaculadad; González-Pinto, Anae; Graell, Montserratf; Moreno, Dolores Maríac; Rapado-Castro, Martac; Arango, Celsoc Author Information

Real-world use of quetiapine in early psychosis: An acute inpatient and community follow-up effectiveness study

Objective. To evaluate the use of quetiapine in first episode psychosis in adolescents and adults in a 26-week open-label trial. Methods. Consenting patients were recruited from consecutive acute psychiatric admissions. Quetiapine was increased stepwise to 750 mg. Baseline, 2, 4, 12, 16, 20 and 26 week measurement included: BPRS, PANSS, CGI, and indices of tolerability and safety. Change was assessed using repeated measures ANOVA. Results. Of 73 first admission patients with psychosis, 15 entered the study. Loss of otherwise eligible patients was mainly related to prospective consent, which appeared to cause selection bias. All 15 patients were retained for 4-week Intention-to-Treat Analysis; nine completed the 26-week protocol (Completers Analysis). Non-completers dropped out shortly after 4 weeks. In the ITT Analysis, there was significant improvement on BPRS Total (P<0.01), PANSS Positive (P<0.05), and CGI (P<0.01) scores. No change in the 2-week BPRS Total score predicted subsequent non-response to quetiapine. In the Completers Analysis, onset of significant PANSS Negative score reduction did not occur until week 12. By 26 weeks all efficacy measures had substantially improved; and substance abuse was markedly less prevalent (P=0.02). Adverse events included postural hypotension, drowsiness, and significant weight gain (P=0.001). Conclusions: This uncontrolled trial suggests quetiapine is an effective first-line treatment in young early psychosis patients. Prospective consent is a major barrier to evaluating acute care for psychotic disorder.